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Cell counts including neutrophils and mediators in induced sputum have been associated with lung function and risk of exacerbations. Emerging approaches to discovering markers of gene-environment interaction include exhaled breath analysis [volatile organic compounds VOCs , exhaled breath condensate], cellular and systemic responses to exposure to air pollution, alterations in the lung microbiome, and biomarkers of lung ageing such as telomere length shortening and reduced levels of sirtuins.

Overcoming methodological challenges in sampling and quality control will enable more robust yet easily accessible biomarkers to be developed and qualified, in order to optimise personalised medicine in patients with COPD.

Chronic obstructive pulmonary disease COPD is a chronic, inflammatory lung disease that arises from exposure to cigarette smoke and other inhaled toxins, and results from a gene-environment interaction 1. This review will initially focus on radiological markers, and biological markers biomarkers in lung tissue, sputum and blood, which may be useful in predicting disease progression in COPD. Emerging approaches to discovering markers of gene-environment interaction will then be discussed, including exhaled breath analysis, exposure to air pollution, the lung microbiome, and lung ageing.